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Article Type

Original Study

Abstract

Objectives Mitral valve (MV) repair in rheumatic patients is a challenging procedure and carries high incidence of early and late failure. We aimed in this study to evaluate the mid-term results of MV bileaflet augmentation to increase the depth of coaptation and achieve satisfactory results of repair. Patients and methods Between January 2015 and December 2018 at the National Heart Institute of Egypt, 24 rheumatic patients had leaflet augmentation with glutaraldehydetreated autologous pericardium as part of their mitral repair procedure. Their clinical and echocardiographic data were prospectively analyzed. Results The mean age of the rheumatic patients was 34.2 ± 14.7 years, range 20–50 years. Overall, 72.4% patients had predominant mitral regurgitation (MR), whereas 27.6% had mixed mitral stenosis and MR. Leaflet augmentation was performed in the posterior, anterior, and both leaflets in 5, 3, and 16 of patients, respectively. Additional repair procedures included commissurotomy and papillary muscle splitting. All repairs were stabilized with annuloplasty rings. The follow-up was complete in all patients with a mean follow-up of 22.4 ± 13.6 months. There was no mortality in this series. At the latest follow-up, the MR grade was none/trivial in eight of patients, mild in four, moderate in six, moderately severe in three, and severe in three patients. Two patients had redo mitral surgery. At 3 years postoperatively, the estimated rates of freedom from reoperation and valve failure were 95.8 and 90.6%, respectively. Conclusion Repair with leaflet augmentation in rheumatic disease resulted in good early and mid-term outcomes. A wider use of this technique may improve the success rate and prognosis of repair in complex rheumatic MV disease.

Keywords

Mitral valve, Rheumatic heart disease, Bileaflet Augmentation

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